Dentin hypersensitivity and toothache among patients diagnosed with Molar-Incisor Hypomineralization: A systematic review and meta-analysis

OBJECTIVES

To determine the prevalence of dentin hypersensitivity (DH) and toothache in patients with Molar-Incisor Hypomineralization (MIH); and evaluate whether patients with MIH have greater likelihood of presenting DH/toothache than controls.

DATA

Studies evaluating DH/toothache in patients with MIH were included. Studies focusing on other enamel defects were excluded.

SOURCES

Eight databases, including grey literature, were searched in January 2024.

STUDY SELECTION

The methodological quality of studies was assessed using the Joanna Briggs Institute checklist for Cross-sectional studies. Proportion and association meta-analyses, subgrouped by diagnostic methods, were conducted. The certainty of evidence was assessed using GRADE approach.

RESULTS

Fifteen studies were included in the qualitative analysis and fourteen in the meta-analyses. Two studies fulfilled all items of the methodological quality checklist. The overall prevalence of DH/toothache among patients with MIH was 45 %. Prevalence rates of 30 %, 47 %, and 55 % were estimated based on proxy reports, self-reports, and air stimulation, respectively. The overall prevalence of DH/toothache per tooth was 22 %, ranging from 16 % to 29 % according to the diagnostic method. Patients with MIH demonstrated higher likelihood of presenting proxy reports of DH/toothache compared to those without MIH (OR: 1.51, 95 % CI [1.23-1.85], P < 0.01, I2: 0 %). The certainty of evidence was very low, mainly due to the low methodological quality of included studies and high inconsistency.

CONCLUSIONS

The global prevalence of DH/toothache was 22 %, per tooth, and 45 % per patient. Estimates vary according to diagnostic methods. Patients with MIH showed higher likelihood of presenting proxy reports of DH/toothache than controls.

CLINICAL SIGNIFICANCE

This systematic review contributes valuable information to the dental literature by assessing the prevalence and associated factors of DH/toothache in patients with MIH. The findings can guide future research, inform clinical practices and public policy makers, and ultimately improve the management of oral health of patients with MIH.

REGISTRATION

PROSPERO CRD42023432805.

Parental oral health literacy influences preschool children's utilization of dental services

Parental behavior towards their children's oral health is strongly influenced by parent's Oral Health Literacy (OHL) level. This study evaluated the impact of parental OHL on preschool children's utilization of dental services. A cross-sectional study was conducted with parents of 419 children aged 3 to 5 years who answered a self-administered questionnaire about their perception of their children's oral health and whether their children had already been to a dental visit. Parental OHL level was assessed by the validated version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) translated into Brazilian Portuguese. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). Most children had already been to a dental visit (73%). Overall, 31.7% of the parents or guardians reported that their children had experienced dental pain or dental caries. Parental OHL level was classified by tercile as low, medium, and high. The final model showed independent associations between children who had already been to a dental visit and higher parental OHL level (PR = 1.16; 95%CI = 1.00-1.35) when compared to the lowest OHL level, higher parental educational level (PR = 1.39; 95%CI = 1.03-1.87) when compared to lower educational level, the report of children's pain and dental caries (PR = 1.22; 95%CI = 1.09-1.36) and married parents or parents in a common-law marriage (PR = 1.17; 95%CI = 1.03-1.93). The prevalence of children who had already been to a dental visit was higher among those parents with a higher OHL level when compared to those with a lower OHL level.

The influence of different dimensions of oral health literacy on parental attitudes and comprehension of an information leaflet about permanent tooth avulsion

BACKGROUND/AIM

Permanent tooth avulsion requires proper management at the time of the accident and parental oral health literacy (OHL) may influence decision-making with regards to dental trauma. The aim of this study was to investigate the influence of OHL on: (1) self-rated comprehension of an information leaflet (IL), (2) self-rated capacity to execute the tasks proposed on the IL, and (3) attitudes regarding the avulsion of a permanent tooth in children.

MATERIAL AND METHODS

A longitudinal study was conducted involving the reading of an IL by 466 parents/caregivers. Evaluations were performed prior to the IL (Phase I), immediately after the application of the IL (Phase II) and 60 days after the application of the IL (Phase III). Self-rated comprehension and capacity to execute the proposed tasks were analyzed in Phase II. Attitude was evaluated in all three phases. Functional OHL was measured using the BREALD-30 and interactive OHL was measured using HeLD-14.

RESULTS

Correlations were found between self-rated comprehension and both the OHL/BREALD-30 score (rs = 0.179; p = .012) and OHL/HeLD-14 score (r = 0.258; p < .001). Correlations were also found between the self-rated capacity to execute the proposed tasks and both the OHL/BREALD-30 score (rs = 0.133; p = .047) and the OHL/HeLD-14 score (rs = 0.225; p < .001). Higher BREALD-30 and HeLD-14 scores were associated with a better performance regarding parental attitudes toward permanent tooth avulsion comparing Phases I and II and Phases II and III (p < .05).

CONCLUSIONS

Higher levels of OHL were associated with better parental self-rated comprehension of the IL and the capacity to execute the tasks proposed therein as well as more adequate attitudes regarding the avulsion of a permanent tooth.

Is oral health literacy associated with conceptions of care and behavior related to the prevention of COVID-19?

The aim of the present study was to investigate the impact of oral health literacy (OHL) on conceptions of care and behaviors related to COVID-19. The sample came from two preliminary cross-sectional studies that determined the level of OHL of parents/guardians of six-to-12-year-old children in two major Brazilian cities (Curitiba and Belo Horizonte). Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14) for the evaluation of interactive OHL. Participants were recruited through e-mail, social media, and telephone contact. The questionnaire on conceptions of care and behaviors related to COVID-19 was created based on the guidelines of the World Health Organization. Two hundred nineteen individuals participated in the study. There was no significant difference in socioeconomic and demographic variables and in the medians of BREALD and HeLD-14 between the two cities (P>0.05). Higher levels of functional OHL were associated with an appropriate conception that individual care affects collective care (P=0.038), but with an inappropriate conception of seeking medical assistance in cases of mild symptoms (P=0.030). Higher levels of interactive OHL were related to social distancing behavior in the city of Curitiba (P=0.049) and in the overall sample (P=0.040). It is concluded that functional OHL was associated with two of the investigated conceptions about COVID-19, while interactive OHL was associated with social distancing behavior. These data may suggest that different dimensions of the OHL can have an impact on different aspects of coping with the pandemic.

Are technology-based health education methods able to reduce oral health inequalities between the sexes in adolescents? A cluster randomized trial

PURPOSE

Determine if different technology-based health education interventions can reduce oral health inequalities between the sexes in a sample of adolescents.

METHODS

A cluster randomized clinical trial was conducted in three phases with an initial sample of 291 male and female adolescents 14-19 years of age. Phase I (n = 288) comprised a clinical examination performed by a calibrated examiner using the simplified oral hygiene index (OHI-S) and gingival bleeding index (GBI). Phase II involved two educational interventions: video (VD; n = 147) or oral counselling (OR; n = 141) with standardized content. In phase III, an App was made available to half of the clusters (OR + App; n = 66/OR without App; n = 71/VD + App; n = 63/VD without App; n = 63), and the clinical examination was performed a second time. Data were evaluated using descriptive analysis and nonparametric tests.

RESULTS

In phase I, boys had a lower standard of oral hygiene compared with girls, with higher mean OHI-S (p = 0.039) and GBI (p = 0.015). After VD and OR interventions, no significant difference between sexes was found regarding the mean OHI-S. However, males had a higher mean GBI compared with females in the OR group (p = 0.006). When the App was added to OR and VD groups, males in the 'OR without App' group had a higher mean GBI compared with females (p = 0.007).

CONCLUSION

This clinical trial demonstrated that educational interventions involving information technologies were effective at reducing oral health inequalities between the sexes among adolescents. However, oral counselling alone was not efficient in reducing GBI in male adolescents.

Access to dental care for patients with inherited bleeding and hemoglobin disorders

AIM

To identify the main barriers to dental care access for patients with inherited bleeding (IBD) and hemoglobin disorders (HbD).

METHODS

Patients with IBD and HbD were invited to participate in this study between August 2019 and March 2020. Data were collected through a questionnaire consisting of socioeconomic and demographic items and questions about access to dental services and history of dental treatment. Univariate and multiple Poisson regression model was used to determine associations between professional refusal of dental care and other co-variables (p < .05).

RESULTS

The participants (29.1%) have already had professional refusal of dental care and participants with IBD (53.2%) did not feel confident with their local dentist due to their bleeding tendency. Most (64.6%) felt apprehensive about visiting the local dentist and high prevalence of refusal to provide dental care was associated with age (prevalence ratio [PR] = 1.021; 95% confidence interval [CI] = 1.010-1.032). Individuals with low bleeding risk were less likely to be denied dental care by a professional compared to those with high bleeding risk (PR = 0.536; 95%CI = 0.291-0.990).

CONCLUSION

Professional refusal of dental care was high among patients with IBD, particularly older adults and with an increased risk of bleeding.

Food insecurity and sociodemographic factors among children in São José dos Pinhais, Paraná, Brazil, 2017: a cross-sectional study

OBJECTIVE

To analyze association between food insecurity (FI) and sociodemographic factors among children.

METHODS

The study was carried out from May to November 2017 with mothers of children (18 - 35 months old) enrolled at public education facilities in São José dos Pinhais, Paraná, Brazil. FI was determined by the Brazilian Household Food Insecurity Measurement Scale. Multinomial logistic regression was used with a hierarchical model.

RESULTS

395 mothers/children participated. Overall FI prevalence was 34.7% (95%CI 28.5;41.5), with prevalence of 25.7% (95%CI 19.2;32.3) for mild FI (MFI) and 9.0% (95%CI 8.5;9.4) for moderate/severe FI (MSFI). Families in the lowest income tercile had higher likelihood of MFI (OR=3.06 - 95%CI 1.26;7.41) or MSFI (OR=6.35 - 95%CI 1.89;21.4) when compared to the highest tercile. Higher MFI prevalence was identified in male children (OR=2.34 - 95%CI 1.49;3.68).

CONCLUSION

FI was associated with lower income and MFI with male children. Public policies to increase income must be included in FI reduction strategies.

Caesarean delivery and early childhood caries: Estimation with marginal structural models in Brazilian pre-schoolers

OBJECTIVE

This study analysed the association between caesarean section and early childhood caries (ECC), estimating the effects using regression and causal inference models.

METHODS

This was a historical cohort study of 697 mother-child dyads, conducted in São Luís, Brazil. The caesarean section was the exposure, and the severity of ECC (dmft) was the outcome. Covariates household income, maternal schooling, maternal hypertension, maternal obesity and birth weight were adjusted for in the models. The effects were estimated by Poisson regression (Means Ratio-MR) and causal inference using a marginal structural model (MSM) (MR and Average Treatment Effect-ATE coefficients), weighted by the inverse probability (IPW) of exposure.

RESULTS

Caesarean section was protective against caries in the bivariate (MR 0.81; CI 0.70-0.94; P = 0.005) and multivariate (MR 0.78; CI 0.67-0.91; P = 0.002) models. In MSM analyses, the caesarean section had no effect on ECC (ATE = -0.35; P = 0.107), controlling for IPW of exposure.

CONCLUSION

The apparent association between caesarean section and ECC severity seems spurious, as it did not persist after employing a superior approach to estimating causality.

Unexpected formation of root-like structures subsequent to the avulsion of immature permanent teeth: Case report

This report describes the unexpected formation of root-like structures following the avulsion of immature permanent teeth without replantation. A 6-year-old female patient had avulsed the four permanent mandibular incisors and the two deciduous mandibular canines. The patient was seen in an emergency healthcare unit but did not receive specialized treatment for tooth replantation. As follow-up treatment, she received a removable prosthesis. After 4 years of follow-up, an image obtained by panoramic radiography showed formations similar to four root structures in the alveolus of the previously avulsed permanent teeth. This finding was confirmed by periapical radiography and computed tomography. This case report demonstrates that in teeth with incomplete root development, even after avulsion without replantation, cells from the pulp stump may have the capacity to form mineralized structures that appear radiographically comparable to root dentin.

MOLAR INCISOR HYPOMINERALIZATION AND CELIAC DISEASE

BACKGROUND

Molar incisor hypomineralization (MIH) is a developmental enamel defect with multifactorial etiology. Although the relationship between celiac disease (CD) and developmental enamel defect was demonstrated, the association between CD and MIH is uncertain.

OBJECTIVE

The objective of this study was to analyze the occurrence of MIH in CD patients.

METHODS

Forty CD patients and a control group with 40 healthy individuals were selected. A calibrated examiner (k≥0.889) according to the European Academy of Pediatric Dentistry criteria performed the diagnosis of MIH. Data were analyzed by descriptive statistics and Fischer's exact test (α=0.05).

RESULTS

Of the 80 participants, ten presented MIH with eight individuals with CD. Celiac patients presented 4.75 times the chance of occurrence of MIH than the control group (95% CI: 2.22-10.18; P=0.044). In all the evaluated teeth (n=978), 22 had MIH: 20 teeth in individuals with CD and two in those without the disease. All CD participants with MIH presented the classic form of the disease. CD participants showed 17 teeth (85.0%) with demarcated opacities, two (10.0%) post-eruptive collapses and one (5.0%) atypical restoration. The control group presented only demarcated opacities.

CONCLUSION

CD increased the chance of MIH and associated with its clinical manifestations can assist in the diagnosis of CD.

Urgency and discontinuity of oral health care in children and adolescents

The aim of the present study was to investigate the discontinuity of oral health care among children and adolescents who accessed emergency services at primary care units and urgent care units. Records were reviewed of patients aged 0 to 17 years treated in the public healthcare system in city of Curitiba, Brazil. Discontinuity was considered when elective treatment was not registered at the primary care unit within six months after urgent care. The sample was stratified based on the Municipal Human Development Index (MHDI) (≤0.799 or ≥0.800). The association between discontinuity and covariables was assessed using univariate and multivariate Poisson regression models with robust variance (α=0.05). The incidence of discontinuity was 42.2%. In the MHDI≤0.799 stratum, the risk of discontinuity was greater among children younger than five years of age and individuals who had not had a dental appointment in the previous year. In both MHDI strata, the risk of discontinuity was higher in patients who received urgent care at an urgent care unit than those treated at a primary care unit. The incidence of the discontinuity of oral health care was high and was strongly influenced by the characteristics of dental service utilization among individuals living in regions with a lower MHDI.

Are Information Technologies Capable of Stimulating the Use of Dental Floss by Adolescents? A Cluster Randomised Clinical Trial

PURPOSE

To analyse the effect of information technologies on improving the frequency of the use of dental floss among adolescents.

MATERIALS AND METHODS

A randomised, controlled clinical trial was conducted with 291 adolescents (mean age: 16.1 years) in three phases. Phase I involved the application of a questionnaire and clinical examinations using the simplified Oral Hygiene Index and gingival bleeding index. In phase II, the adolescents were randomly allocated to four groups: oral counseling (OR) and the use of an application (App) for smartphones; OR without the app; video (VD) and app; and VD without app. Messages were set through the app for 30 days. Phase III involved the second administration of the questionnaire and clinical examination. The frequency of dental floss use was evaluated in phases I and III. The groups were categorised into the use of technology (VD and/or App) and non-use of technology (OR alone).

RESULTS

Statistically significant reductions in the clinical indices were found with all educational methods (p < 0.005) and improvements were found in the use of dental floss (p < 0.001). Moreover, information technologies were associated with an improvement in the frequency of dental floss use (p < 0.033).

CONCLUSION

All methods were effective at improving clinical indicators. The use of information technologies can be considered an effective tool for improving dental floss use among adolescents.

Caregiver oral health literacy: relationship with socioeconomic factors, oral health behaviors and perceived child dental status

OBJECTIVE

To assess associations between caregiver oral health literacy (OHL) and socioeconomic factors, child and caregiver's oral health behaviors and perceptions of oral health status.

BASIC RESEARCH DESIGN

Cross-sectional study.

CLINICAL SETTING

University pediatric dentistry clinic.

PARTICIPANTS

205 pairs of caregivers and children aged 6 to 12-years undergoing dental treatment.

METHOD

A questionnaire was sent to caregivers enquiring about socioeconomic factors, oral health behaviors, perceptions of own and child oral health. The clinical dental status of the children was recorded with the DMFT/dmft index.

MAIN OUTCOME MEASURE

OHL was measured by the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Descriptive analysis, unadjusted and adjusted logistic regression, odds ratio and confidence interval were calculated considering a significance level of 5%.

RESULTS

The frequency of poor OHL was 21%. In adjusted analysis caregivers with 8 years or less of schooling had a 3.72 (95% CI 1.74-7.95) times greater chance of have poor OHL. Caregivers who perceived their child to have poor oral health were 2.70 (95% CI 1.10-6.63) times more likely to have poor OHL.

CONCLUSIONS

Poor oral health literacy was more common among caregivers with less schooling and a poor perception of their child's oral health. OHL was unrelated to monthly family income, child dental health status, perception of own oral health or child or caregiver oral health behaviors.

Periostitis ossificans in a 10-year-old child

Periostitis ossificans (PO) is a type of osteomyelitis stemming from an odontogenic infection, generally found in children and adolescents, and often leads to the loss of the involved tooth. This case presents a less invasive alternative for the treatment of PO. A 10-year-old patient presented with an asymmetrical increase in the left side of the mandible. Tooth 36 exhibited pulp necrosis and incomplete root formation. Radiographically, the bone in the region had the appearance of the layers of an onion. Computed tomography indicated periosteal bone proliferation in the region of the ramus and angle of the mandible adjacent to the vestibular cortical bone. Therapy involved root canal preparation and intracanal medication with calcium hydroxide in tooth 36. Complete remission of the condition occurred within 14 months. In conclusion, endodontic intervention is a less invasive alternative and should be considered to minimize the negative impact of tooth loss in children.

Systemic Exposures Associated with Hypomineralized Primary Second Molars

Purpose: Hypomineralized primary second molars (HPSMs) are clinically represented by demarcated opacities in the enamel, involving from one to four primary second molars. The purpose of this cross-sectional study was to investigate the systemic exposures associated with hypomineralized primary second molars. Methods: A representative population-based sample of 731 eight-year-old children was randomly selected. Data on systemic exposures were collected via a structured questionnaire given to the children's mothers. The HPSMs were clinically assessed by calibrated examiners according to the modified-DDE (developmental defects of enamel) index and European Academy of Paediatric Dentistry criteria. Associations were analyzed by Poisson multiple regression considering a temporal hierarchical approach. Results: The prevalence of HPSMs was 9.4 percent (95 percent confidence interval equals 7.0 to 12.0 percent). Children whose mothers presented with hypertension were found with an Adjusted Prevalence ratio (PRa) of 1.73 (P=0.044) and mothers who used tobacco (PRa equals 2.44; P=0.001) during pregnancy had a significantly higher prevalence of HPSMs. The presence of complications during delivery (PRa equals 1.83; P=0.032) and the occurrence of otitis media during early childhood (PRa equals 1.68; P=0.043) also presented a higher prevalence of HPSMs. Conclusion: The use of tobacco, presence of hypertension, complications during delivery, and otitis media during the first years of a child's life are associated with a higher prevalence of hypomineralized primary second molars. (Pediatr Dent 2019;41(5):364-70).

Demarcated opacity in primary teeth increases the prevalence of molar incisor hypomineralization

This cross-sectional study aimed to assess the prevalence of molar incisor hypomineralization (MIH) and its relationship with the number of primary teeth with developmental defects of enamel (DDE). A representative population-based sample of 731 schoolchildren was randomly selected from the public school system in Curitiba, Brazil. Schoolchildren aged 8 years with fully erupted permanent first molars and incisors were eligible for the study. MIH and DDE were classified by four calibrated examiners (kappa > 0.75) according to EAPD criteria and to the FDI-modified DDE index. Clinical data were collected in a school environment. Socioeconomic information was collected through a self-administered semistructured questionnaire applied to the children's caregivers. Statistical analyses were carried out using Poisson multiple regression with robust variance (α = 0.05). MIH prevalence was 12.1% (95%CI: 10-15), and opacities were the most prevalent defect. Socioeconomic factors were not associated with MIH. Children with demarcated opacity in primary teeth presented a higher prevalence of MIH than those without DDE in primary teeth. In the multiple analysis, the increase of one primary tooth affected by demarcated opacity increased the prevalence of MIH by 33% (PR = 1.33, 95%CI: 1.15-1.53, p < 0.001). Asian children had a higher prevalence of MIH (PR = 2.91, 95%CI: 1.08-8.09 p = 0.035) than did Caucasian children.Conclusion: Based on these findings, the prevalence of MIH in Curitiba was 12.1%. Demarcated opacity in primary teeth could be considered a predictor of MIH.

Caregiver’s oral health literacy is associated with prevalence of untreated dental caries in preschool children

Abstract The aim of this study was to evaluate the relationship between oral health literacy (OHL) among caregivers and untreated dental caries among preschoolers. A cross-sectional study was conducted involving 415 preschool children and their caregivers from Curitiba, Brazil. The children were examined for dental caries and dental plaque. The caregivers’ OHL was evaluated using an instrument translated and validated for Brazilian Portuguese: the Brazilian Rapid Estimate of Adult Literacy in Dentistry-30. The prevalence of children with untreated caries was 42.9% (95%CI: 38.1-47.7%). A low degree of OHL was found among 15.7% (95%CI: 12.2-19.2) of caregivers. The multivariable Poisson regression analysis indicated a higher prevalence of untreated caries among children whose caregivers had a low OHL (PR = 1.35; 95% CI: 1.01-1.79), those with visible plaque (PR = 1.28; 95% CI: 1.01-1.62) and those who never or only occasionally had their teeth brushed by their caregivers (PR = 1.48; 95% CI: 1.16-1.91) in comparison to those without these conditions. In conclusion, a higher prevalence of untreated dental caries was found among preschool children whose caregivers had a low degree of OHL.

Impact of molar incisor hypomineralization on quality of life in children with early mixed dentition: A hierarchical approach

BACKGROUND

Molar incisor hypomineralization (MIH) is associated with unfavourable dental conditions such as dental caries and may consequently impact oral health-related quality of life (OHRQoL).

OBJECTIVE

To assess the impact of MIH on OHRQoL in children with early mixed dentition.

METHOD

A population-based cross-sectional study of 728 8-year-old children from the public school system in Curitiba, Brazil, was conducted. The Child Perception Questionnaire for 8- to 10-year-olds (CPQ_8-10 ) was used to evaluate OHRQoL. MIH was diagnosed according to the European Academy of Paediatric Dentistry (EAPD) criteria. The assessments of MIH, dental caries, and malocclusion were performed by four calibrated examiners (κ ≥ 0.80). Demographic and socioeconomic data (DSE) were obtained from the children's parents/caregivers using a structured questionnaire. The analysis of OHRQoL determinants was performed through a three-level hierarchical approach: mesial (DSE), intermediate (clinical conditions), and distal (child's oral self-perception), using Poisson regression with robust variance (α = 0.05).

RESULTS

The prevalence of MIH was 12.1% (95% CI: 10-15). An association was found between MIH and OHRQoL in the "oral symptoms" domain of the CPQ_8-10 (PR: 1.07, 95% CI: 1.03-1.11, P < 0.001) after adjusting for other clinical variables and DSE.

CONCLUSION

Molar incisor hypomineralization was associated with a greater impact on OHRQoL in children's oral symptoms.

Knowledge of parents/caregivers about the sleep bruxism of their children from all five Brazilian regions: A multicenter study

BACKGROUND

Sleep bruxism (SB) is a masticatory muscle activity that affects children. Parents' knowledge is important for its identification and report to dentists.

AIM

To investigate parents' knowledge about SB among their children.

DESIGN

A cross-sectional study included 1325 parents of children from dental clinics of seven institutions from all regions of Brazil. Parents answered questions about child's sleep, knowledge about SB and its occurrence among children and parents. SB definition given by parents was dichotomized as "correct"/"incorrect", based on the American Academy of Sleep Medicine definition. Descriptive, bivariate and multivariate analyses were performed (P < 0.05).

RESULTS

Most parents (57.3%) did not know what SB is and 88.9% would like to receive more information. SB prevalence among parents was 15.4% and 24.0% among children. Between parents who correctly defined SB, its prevalence increased to 27.5% among parents and 40.6% among children. Parents whose children had/have SB, who would like to receive more information about SB and were from the North, Central-West, Southeast, and South regions were more likely to define SB correctly (P > 0.05).

CONCLUSION

There is a lack of knowledge of parents about SB. SB among children, parents' interest in receiving more information and their location were factors associated to their knowledge.

No-shows at public secondary dental care for pediatric patients: a cross-sectional study in a large Brazilian city

Abstract Missed appointments have a great economic, social and administrative impact on the management of public health services. This research aimed to study factors associated with non-attendance to the first appointments of pediatric patients in secondary dental care services in the city of Curitiba, Brazil. A cross-sectional study was performed using secondary data from the electronic health records of the Curitiba Municipal Secretary of Health. The study included all children (0-12 years) referred to secondary dental clinics in the years 2010 to 2013. Data were analyzed by the chi-square test and Pearson linear trend chi-square (α = 0.05). Binary logistic regression models were built. Data from 1,663 children were assessed and the prevalence of non-attendance was 28.3%. The variables associated with the non-attendance in inferential analysis (p < 0.05) and in the final model were the household income per capita (95% CI: 1.93-2.82) and the waiting time in virtual queue (95% CI: 1.000-1.002). Socioeconomic aspects and the waiting time in virtual queue, should be considered in the strategic planning of health services as they may influence the attendance of pediatric patients in secondary dental referral service.

How much does household food insecurity explain income inequalities in untreated dental caries?

BACKGROUND

The pathway by which socioeconomic disadvantages are manifested in the occurrence of dental caries remains unclear.

AIM

To explore how much the association between untreated dental caries and income inequalities is related to household food insecurity (HFI).

DESIGN

A population-based study was conducted with a sample of 466 12-year-old students. Dental caries was evaluated by an examiner who had undergone calibration exercises. HFI was assessed using the Food Insecurity Scale validated for Brazilian Portuguese. Poisson regression models were created to determine associations between dental caries and both household income and HFI. The proportion of the income effect on dental caries explained by HFI was determined by the variation in percentages between the crude prevalence ratio (PR_c ) for dental caries and this measure adjusted by HFI (PR_a ).

RESULTS

The prevalence of dental caries was higher among children from families with a per capita household income lower than US$ 71 (PR: 1.69; 95%CI: 1.15-2.49) or from US$ 71 to US$ 142 (PR: 1.50; 95%CI: 1.04-2.17). Moreover, 14% of the association between a low income and dental caries was explained by HFI.

CONCLUSIONS

Differences in the prevalence of dental caries in schoolchildren related to socioeconomic inequalities could partially be attributed to HFI in low-income families.

Impact of oral health literacy on self-reported missing data in epidemiological research

OBJECTIVES

To investigate whether oral health literacy (OHL) impacts missing data obtained through self-reporting in oral health epidemiological research.

METHODS

A cross-sectional study was conducted with parents (n = 344) of 4- to 5-year-old children randomly selected from public schools within the city of Curitiba, Brazil. Parental OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Parents answered a set of questionnaires comprising 88 items concerning sociodemographic and economic data, children's access to dental services, oral hygiene behaviour, diet and mealtime behaviour. The total number of unanswered items (TUI) and the number of unanswered items in each type of question (open-ended, dichotomous, multiple choice with up to 4 options and with 5-9 options) for each participant was compared across different levels of OHL (chi-squared, Mann-Whitney, Kruskal-Wallis and Spearman's correlation test). Multiple Poisson regression was used to estimate rate ratios (RR) of TUI between OHL scores and their respective 95% confidence interval (95% CI).

RESULTS

Approximately one-third of studied parents (37%) exhibited low OHL (BREALD-30 ≤ 21). The prevalence of missing data in at least one item was 85.5%. Low OHL was associated with failing to respond open-ended items (P = 0.003) and multiple-choice items with up to 4 (P = 0.003) and between 5 and 9 options (P = 0.030). There was a negative correlation between OHL scores and TUI (r = -0.195; P < 0.001), as well as with the number of unanswered items in all types of questions (P < 0.01), except dichotomous questions. Parents with lower OHL were more likely to show higher values of TUI (RR 0.95: 0.93-0.98), when adjusted by income and education.

CONCLUSIONS

Participants with lower OHL were significantly more likely to fail to complete research questionnaires. The impact of OHL on missing data was greater with more complex types of items.

Healthy and cariogenic foods consumption and dental caries: A preschool-based cross-sectional study

OBJECTIVE

To evaluate the association of the consumption of healthy and cariogenic foods with the prevalence of untreated dental caries among preschool children.

MATERIALS AND METHODS

A cross-sectional study was conducted with 427 5-year-old preschoolers. Caries was evaluated through a clinical examination using dmft index. Parents/guardians answered a questionnaire addressing socioeconomic status, eating frequency, and oral hygiene habits.

RESULTS

The prevalence of untreated caries was 51%. The multiple models demonstrated a seven percent increase in the prevalence of untreated caries with each additional daily contact with cariogenic foods, whereas a four percent reduction in this prevalence rate was found for each additional contact with healthy foods. When the number of daily contacts with cariogenic and healthy foods was incorporated into the same model, the former reached only borderline statistical significance (p = 0.05), whereas the latter maintained an association with lower caries rates (p = 0.01).

CONCLUSION

A dietary assessment based solely on the frequency of the consumption of cariogenic foods may not be sufficient to understand the occurrence of dental caries in preschool children. It is necessary a more comprehensive evaluation of the dietary pattern, once a healthy diet can present an association with lower prevalence of caries even among preschool children who consume cariogenic foods.

Is parental oral health literacy a predictor of children's oral health outcomes? Systematic review of the literature

BACKGROUND

The scientific evidence regarding the association between parental oral health literacy (OHL) and children's oral health is unclear.

AIM

To evaluate the scientific evidence concerning the association between parental OHL and children's oral health outcomes.

DESIGN

Eight databases were searched. Studies that evaluated oral health outcomes among children and measured parental OHL through a validated tool were included. Two independent reviewers selected studies, extracted data and analysed the risk of bias.

RESULTS

Eleven studies were included. Most (n = 6) had a high risk of bias. Most studies evaluating dental caries found association between lower parental OHL and higher prevalence/experience of dental caries. Poor oral health-related quality of life was associated with decreased parental OHL (P < 0.05). Studies diverged on the association between OHL and the number of filled, extracted teeth, and dental visits. There was no association between children's tooth brushing frequency, use of toothpaste, oral health claim, oral health expenditures and parental OHL. The literature was inconclusive regarding the association between night bottle feeding, negative parental perception of the child's oral health and OHL.

CONCLUSION

Low parental OHL was associated with dental caries among their children. It is too soon to assume an association between OHL and the remaining outcomes.

Improving adolescents' periodontal health: evaluation of a mobile oral health App associated with conventional educational methods: a cluster randomized trial

BACKGROUND

Adolescence is a decisive period in the construction of new conduits.

OBJECTIVE

The influence of an App associated with conventional educational methods in adolescents' oral health.

STUDY DESIGN

Randomized controlled trial including 291 participants (mean age = 16.1 years) in baseline. The study consisted of four phases. Interventions were evaluated through the knowledge score (KS) and oral indexes (OHI-S/GBI). KS was obtained through five affirmations about periodontal diseases applied in different moments (pre-test, post-test, and follow-up test). Phase I included pre-test and oral clinical examination. Sample was randomly divided into two groups: oral (OG) and video orientation (VG) and post-test (phase II). Phase III characterized the formation of groups: OG + App/OG without App/VG + App/VG without App. App consisted of reinforcement messages which was sent during 30 days. Phase IV comprised follow-up test and clinical evaluation.

RESULTS

There was no significant difference in KS between OG/VG. Overall, App improved KS (P < 0.001). VG + App showed a significant increase in KS in the follow-up test compared to the post-test (P = 0.046). There was a significant reduction in oral indexes for all methods.

CONCLUSION

App was effective in increasing knowledge, especially associated with video. The different methods were equally effective for a better standard in oral hygiene.

Association of oral health literacy with oral health behaviors, perception, knowledge, and dental treatment related outcomes: a systematic review and meta-analysis

OBJECTIVES

To conduct a systematic review and meta-analysis regarding the association of oral health literacy (OHL) with oral health behaviors, perception, knowledge, and dental treatment related outcomes.

METHODS

Eight electronic databases were searched up until June 2017. Studies regarding the aforementioned outcomes measuring OHL through a validated instrument and in which OHL was an explanatory variable were included. Two independent reviewers selected studies, extracted data, and analyzed the risk of bias of the studies. Meta-analysis using random effect modeling was undertaken. Pooled estimates were calculated with 95 percent confidence interval (CI) and odds ratios (OR).

RESULTS

Twenty-five studies were included in the systematic review and three in the meta-analysis. Most studies were cross-sectional (n = 21) and had a high risk of bias (n = 17). The meta-analysis showed no association between OHL and frequency of visit to the dentist for adults, either through bivariate analysis (OR = 1.25; 95 percent CI: 0.95-1.63) or multivariate analysis (OR = 1.90; 95 percent CI: 0.77-4.84). Dental anxiety and night bottle-feeding were associated with low OHL (P < 0.05). Most studies regarding tooth brushing frequency found no association with OHL. Most studies regarding oral health knowledge related outcomes reported an association with higher OHL. The literature was inconclusive regarding the association between OHL and dental treatment outcomes, oral health behaviors, and oral health perception.

CONCLUSIONS

The current scientific evidence suggests that no association exists between OHL and any of the outcomes investigated. Further prospective studies with a higher methodological quality are necessary to confirm the evidence.

Oral Health Literacy as a Predictor of Dental Anxiety in Parents of Children Undergoing Dental Treatment

PURPOSE

The purpose of this cross-sectional study was to evaluate the association between parents' dental anxiety (DA) and independent variables.

METHODS

One hundred sixty-eight dyads of parents and six- to 12-year-old children who were undergoing treatment at a university pediatric dentistry clinic were recruited. Two examiners evaluated parents' DA and oral health literacy (OHL) using the Brazilian version of Corah's dental anxiety scale and the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), respectively. Children's DA was reported by parents through the dental anxiety question (DAQ). Demographic data was also collected. A single examiner used the decayed, missing, and filled permanent teeth and primary teeth (DMFT/dmft) indices to assess the children's oral health status. The data analysis involved univariate and multivariate Poisson regression.

RESULTS

In the multivariate regression, higher levels of parents' DA were associated with a household income equal to or less than the Brazilian monthly minimum wage (prevalence ratio [PR]=4.9; 95 percent confidence interval [CI]=2.1 to 11.7) and a lower degree of OHL (PR=1.68; 95 percent CI=1.01 to 2.8). Associations between parents' DA and children's DA and DMFT/dmft index were not found.

CONCLUSION

Parents' dental anxiety was related to a low household income and low oral health literacy.

Oral Health Literacy and Retention of Health Information Among Pregnant Women: A Randomised Controlled Trial

PURPOSE

This study evaluated the effect of oral health literacy (OHL) on the retention of health information in pregnant women.

MATERIALS AND METHODS

A total of 175 pregnant women were randomly assigned to standard oral (spoken), written and control intervention groups. With the exception of the control group, the interventions investigated the eating habits and oral hygiene among children under 2 years of age. The participants' answers before the interventions (pre-test), 15 min after the interventions (post-test) and 4 weeks after the interventions (follow-up test) were used to estimate the knowledge score (KS). Information acquisition was determined by comparing pre-test and post-test results, while retention of information was based comparing pre-test and follow-up test results. OHL was analysed by BREALD-30. The data were assessed by nonparametric tests and Poisson regression models with robust variance (α = 0.05).

RESULTS

By the end of the follow-up period, 162 pregnant women had been assessed. The BREALD-30 mean was 22.3 (SD = 4.80). Regardless of the type of intervention, pregnant women with low OHL had lower knowledge scores in the three assessments. Participants with low OHL showed higher acquisition and retention of information in the standard oral health intervention. Multiple regression models demonstrated that OHL was independently associated with KS, age, socioeconomic status and type of intervention.

CONCLUSION

The results suggest a negative effect of low OHL on retention of information. Only the standard, spoken oral health intervention could address the differences in literacy levels.

Oral health literacy and associated oral conditions: A systematic review

BACKGROUND

The authors systematically reviewed the scientific evidence regarding an association between oral health literacy (OHL) and oral conditions.

TYPES OF STUDIES REVIEWED

The authors performed an electronic search of 8 databases up through October 2016, as well as a manual search. The authors included studies in which the investigators evaluated oral conditions and measured OHL through a validated tool and studies in which OHL was an explanatory variable. The authors assessed risk of bias by using the Newcastle-Ottawa Scale.

RESULTS

The authors included 10 cross-sectional studies. Risk of bias was high in most studies (n = 6). Dental caries and periodontal status were the most common oral conditions reported (each outcome was reported in 5 studies). Investigators in 4 studies found a statistically significant association between dental caries and lower levels of OHL (P < .05), with investigators in 3 of the studies finding this in primary teeth. A reduced number of teeth and loss of attachment were associated with lower levels of OHL (P < .05). Findings for deep periodontal pockets, bleeding on probing, severity of periodontal disease, history of extractions, dental treatment need, and dental plaque were inconclusive. Investigators barely reported other clinical conditions such as temporomandibular joint problems, oral mucosal lesions, enamel opacities, dental fluorosis, and use of and need for dental prostheses.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

There seems to be a weak association between lower levels of OHL and dental caries in primary teeth. Similar findings for adults and between OHL and other oral conditions remain unsubstantiated because the results are controversial, with considerable clinical and statistical heterogeneity between studies.

Profile of orofacial dysfunction in Brazilian children using the Nordic Orofacial Test-Screening

OBJECTIVE

The parameters of orofacial dysfunction (OFD) in children can guide clinicians and researchers in the monitoring of deviations from normality. The aim for this study was to evaluate manifestation patterns and the prevalence of OFD in children.

MATERIALS AND METHODS

A population-based cross-sectional study was conducted involving 531 schoolchildren (8-10 years old) in a small city in southern Brazil. OFD was evaluated using the Nordic Orofacial Test-Screening (NOT-S). Poisson multiple regression analysis with robust variance was used to estimate adjusted NOT-S rate ratios (ratio of arithmetic means) among the different categories of covariables and their respective 95% confidence interval (RR: 95%CI).

RESULTS

The mean NOT-S score was 2.1 (SD 1.4, median: 2.0; range: 0-8). The majority of children (87.6%) had at least one domain of the scale affected. The most affected were Chewing and Swallowing (50.5%), Habits (41.4%) and Breathing (26.4%). NOT-S scores were lower among children from higher income families (RR = 0.73; 95% CI: 0.61-0.87) and higher among those with difficulty regarding access to dental services (RR = 1.14; 95% CI: 1.01-1.28), those with sleep bruxism (RR = 1.18; 95% CI: 1.04-1.32) and those with open bite (RR = 1.65; 95% CI: 1.42-1.93).

CONCLUSIONS

The prevalence of OFD was high and both socioeconomic and clinical factors exerted an influence on NOT-S scores.

Agreement between two different approaches to assess parent-reported sleep bruxism in children

INTRODUCTION

Parents' report is the most used method for the study of sleep bruxism (SB) in children, especially in research with large samples. However, there is no consensus about the questions used to assess SB, what may difficult the comparisons between studies.

OBJECTIVE

The aim of this research was to evaluate the agreement between two different approaches to assess possible sleep bruxism (PSB) in children using parents' report.

METHODS

This cross-sectional study was conducted with 201 parents/caregivers. Prior to the questionnaire completion, all participants received a standard explanation of SB concept. Subsequently, the parents/caregivers answered a general question (GQ) and a frequency-time question (FTQ) about SB, and the answers were compared.

RESULTS

The majority of the participants were the children's mothers (73%) and the childrens mean age was 7.5 years (SD: 2.25). PSB frequency in children did not differ statistically through the two questions [GQ: 30.7% (CI95%: 24.2 - 37.1) and FTQ: 26.6% (CI95%: 20.4 - 32.8)], and an almost perfect agreement was observed between the answers (kp=0.812). Nevertheless, the FTQ showed a more coherent relation with the factors already recognized as associated with childhood bruxism than GQ.

CONCLUSIONS

Different approaches result in similar PSB frequency, however, they show different ability to identify PSB associated factors and suggest the need of questions including frequency and time in further studies.

A population-based study on the impact of orofacial dysfunction on oral health-related quality of life among Brazilian schoolchildren

OBJECTIVE

The aim of the present study was to assess the impact of orofacial dysfunction on oral health-related quality of life (OHRQoL) among Brazilian schoolchildren.

MATERIAL AND METHODS

A population-based study was conducted with 531 children aged eight to 10 years at schools in the city of Campo Magro, Brazil. The Brazilian version of the Child Perceptions Questionnaire (CPQ_8-10) was the outcome variable used to measure the impact on OHRQoL. The main independent variable was orofacial function, which was diagnosed using the Nordic Orofacial Test-Screening (NOT-S). Descriptive, bivariate and multiple Poisson regression analyses were performed using a multilevel approach, with the significance level set to 5%.

RESULTS

The mean (±SD) total CPQ_8-10 score was 13.95 ± 0.5. The multilevel Poisson regression model revealed that the mean CPQ8-10 score was higher among girls (RR: 1.38, 95% CI: 1.17-1.63; p < 0.001) than boys and that children from families with a higher income had lower CPQ_8-10 scores (RR: 0.67, 95% CI: 0.51-0.88; p = 0.004) than those from families with a lower income. Children who sought dental care due to pain or factors other than prevention (RR: 1.41; 95% CI: 1.18-1.68), those with orofacial dysfunction (RR: 1.62; 95% CI: 1.30-2.02) and those with a history of traumatic dental injury (RR: 1.39; 95% CI: 1.15-1.69) also experienced a greater impact on OHRQoL.

CONCLUSIONS

Schoolchildren with orofacial dysfunction experience a greater negative impact on OHRQoL.

The influence of glycemic control on the oral health of children and adolescents with diabetes mellitus type 1

OBJECTIVE

To evaluate the influence of disease control, expressed by the mean values of glycated hemoglobin (HbA1c), in the oral health of children and adolescents with diabetes mellitus type 1 (T1DM).

SUBJECTS AND METHODS

A cross sectional study involving 87 children and adolescents (59 girls), 10 ± 2.6 years old. The participants were divided into three groups: HbA1c ≤ 8%, 8% < HbA1c ≤ 10% and HbA1c > 10%. The duration of the disease, age and average HbA1c were obtained from their medical records. Oral health was evaluated according to the following indexes: Simplified Oral Hygiene Index (OHI-S); Community Periodontal Index (CPI); Decayed, Missing or Filled Teeth Index (DMFT/dmft) for permanent and deciduous teeth; and the stimulated salivary flow rate (SSFR).

RESULTS

The median SSFR was 1.1 mL/min in the group with HbA1c ≤ 8%, 0.7 mL/min in the intermediary group and 0.6 mL/min in the HbA1c > 10% group. A significant decrease in salivary flow was observed with an increase in HbA1c (p = 0.007). The DMFT/dmft and CPI indexes were higher in individuals with higher HbA1c values. More caries-free individuals were found in the group with HbA1c ≤ 8% compared to those with HbA1c > 10%. The group with HbA1c > 10% exhibited more caries and bleeding gums than the other groups. HbA1c values in girls were higher than in boys.

CONCLUSION

Children and adolescents with unsatisfactory glycemic control, represented by higher HbA1c concentrations, exhibited a higher frequency of caries and gingivitis, and a reduction in salivary flow.

Association between untreated dental caries and household food insecurity in schoolchildren

Abstract The aim of the present study was to assess the association between untreated dental caries (UDC) and household food insecurity (HFI) among schoolchildren in different income strata. A population-based study was carried out with a sample of 584 12-y-old schoolchildren. Oral examinations were performed and HFI was determined using a validated scale. Other independent variables were analyzed for being of interest to the stratification of the results (per capita household income) or for acting as potential confounding variables. The prevalence of UDC and HFI was 45% and 39%, respectively. The multivariate models demonstrated that the UDC was significantly more prevalent among children in food-insecure households with per capita income of up to US$ 70.71 than among those in the same income stratum that were free of HFI [PR = 1.52 (95%CI = 1.01-2.29)]. HFI was associated with a greater frequency of UDC among low-income schoolchildren, but had no significant impact on this variable among children from other income strata. Thus, ensuring access to quality food may be a good strategy for minimizing inequities in oral health and reducing dental caries experience among schoolchildren from low-income families.

Impact of Oral Health Status on the Oral Health-Related Quality of Life of Brazilian Male Incarcerated Adolescents

PURPOSE

To assess the impact of oral health status on the oral health-related quality of life (OHRQoL) of incarcerated Brazilian male adolescents.

MATERIALS AND METHODS

A cross-sectional survey with 102 male adolescents incarcerated at the São Francisco Juvenile Detention Facility, Piraquara, Brazil in 2010 was carried out. Dental caries, oral hygiene, periodontal status, malocclusion, dental fluorosis and dental trauma were analysed. The Oral Health Impact Profile (OHIP-14) was administered to measure OHRQoL, along with a questionnaire addressing sociodemographic variables, health-related aspects and dental experience. Descriptive statistical analysis and univariate and multiple Poisson regression with robust variance were performed.

RESULTS

The prevalence of adolescents who reported an impact on OHRQoL was 64% (95% CI: 54-73) and the mean OHIP-14 score was 6.69 (SD = 8.79; median = 3.00). In the multiple regression model, the prevalence of a negative impact on OHRQoL was significantly higher among individuals with untreated caries (PR = 1.74; 95% CI: 1.10-2.77), those who reported having discomfort in the teeth or mouth (PR = 1.33; 95% CI: 1.03-1.73), using tobacco prior to internment (PR = 1.53; 95% CI: 1.04-2.24) and maintaining a stable relationship (PR = 1.31; 95% CI: 1.01-1.70) in comparison to individuals who did not exhibit these conditions. Moreover, each month of internment represented an increase in the prevalence of an impact on OHRQoL (PR = 1.03; 95% CI: 1.01-1.06).

CONCLUSION

Incarcerated male adolescents reported that oral health problems exerted an influence on quality of life, with untreated caries exhibiting the greatest impact.

Hypohidrotic ectodermal dysplasia: a clinical case with a longitudinal approach

AIM

This paper describes a clinical case of a male with hypohidrotic ectodermal dysplasia submitted to rehabilitation and occlusal dental interventions with follow-up from 3 to 14 years of age.

BACKGROUND

Due to the severe effects on function and esthetics, the clinical manifestations of ectodermal dysplasia exert a negative impact on quality of life. However, oral rehabilitation in childhood poses a challenge due to growth and development.

CASE DESCRIPTION

A male with hypohidrotic ectodermal dysplasia began dental intervention at the age of 3 years. The clinical and radiographic exams revealed the absence of several primary and permanent teeth and abnormal shape of the primary maxillary incisors. The facial characteristics were compatible with hypohidrotic ectodermal dysplasia, such as a prominent brow, everted lips, fattened bridge of the nose and small vertical facial height. The treatment proposed involved rehabilitation through successive temporary partial dentures, functional orthopedics of the jaws, esthetic reconstruction of the anterior teeth, timely occlusal intervention and preventive actions for the control of dental caries and plaque.

CONCLUSION

The present case demonstrates that early care plays a fundamental role in minimizing the biopsychosocial consequences of hypohidrotic ectodermal dysplasia and preparing the patient for future oral rehabilitation.

CLINICAL SIGNIFICANCE

Although, the literature offers a number of papers describing dental treatment for ectodermal dysplasia, few cases include long-term follow-up and the use of a functional orthopedic appliance in combination with removable dentures in such patients.